ACR Bulletin April 2018

April 2018 Case of the Month

Internal border-zone infarction secondary to an internal carotid artery dissection


Access case here.


Parth H. Patel, BS
Medical Student
Saint Louis University School of Medicine
Saint Louis, MO

Michael S. Moritz, MD
PGY-5, Radiology Resident, Diagnostic Radiology,
Department of Radiology
Saint Louis University School of Medicine
Saint Louis, MO

Talha Allam, MD
Assistant Professor of Radiology,
Department of Radiology
Saint Louis University School of Medicine
Saint Louis, MO

Team Trajectory

Radiologists who take the time to understand their team’s processes are better equipped to make their practices more efficient and effective.


While many radiologists count notable achievements through individual efforts, the success of their practices (and ultimately the well-being of their patients) can wither if they do not understand how the collective healthcare imaging chain functions. Knowing how the imaging process works — from scheduling to interpreting to follow-up treatment — is critical to maximizing quality, efficiency, profitability, and patient satisfaction. The radiologist’s value as a physician becomes less clear when he or she doesn’t identify as being a member of a team.

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It Takes an Army

Radiologists should foster a team environment to ensure their practices run efficiently and effectively.

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Those of us in the trenches know what it takes to run a successful radiology practice. The bigger the group, the more unique roles are necessary to ensure that all the moving parts are well-oiled and running seamlessly. From front-office staff to billers and coders, radiology practices need a host of different contributors to function as a cohesive unit. Within this unit, radiologists are typically captains of specific care teams, and practice leaders function like admirals of the fleet. Regardless of one’s role within a practice, whether it be private practice or academic, radiologists at all levels need to lead diverse groups, even if it means simply guiding the team through the daily schedule of patients.

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Meaningful Measures

The ACR Commission on Economics supports the Commission on Quality and Safety as we move toward meaningful measures.

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Radiologists are being scored on more measures than ever before. For instance, the Merit-Based Incentive Payment System (MIPS) scores us on four performance categories, which include 271 quality measures (plus 30 more if we were to include the ACR Quality Clinical Data Registry [QCDR]), two cost measures (with more episode-based cost measures to come in 2019), 15 Advancing Care Information measures, and 93 improvement activities. That totals 411 measures. Granted, not every one of these measures applies to radiology. But you get the idea — that’s a lot of measures. CMS administrator Seema Verma, MPH, agrees. In the fall of 2017, she stated, “We have too many measures. We are measuring processes and not outcomes…And we’re announcing today our new comprehensive initiative, ‘Meaningful Measures.’”1

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Final Read

Melissa M. Chen, MD

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Q: When did you know you wanted to be a radiologist?

It was yet another late night at work in the early summer of 2003. I was in my second year as an investment banker at J.P. Morgan, when I decided to switch careers. I had essentially been on call 24 hours a day, 7 days a week for two years, and the lack of meaning in the work that I was doing finally caught up to me.

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Advancing Quality Improvement

For a decade, the National Radiology Data Registry has been building a trove of benchmarking information to help practices improve patient care and make metrics-driven business decisions.

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 This year, the National Radiology Data Registry (NRDR®), is celebrating its tenth anniversary. Over the past decade, NRDR has evolved to stay relevant in the changing healthcare environment.

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Putting Learning Into Practice

Radiologists use knowledge from ACR Education Center courses to improve patient care.

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When Daniel J. Durand, MD, chair of radiology at LifeBridge Health in Baltimore, enrolled in the coronary CTA course at the ACR Education Center, he didn’t realize how quickly he would translate what he had learned into practice and impact patient management.

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Assessing Radiology Residents

RadExam gives program directors an ongoing, specialized assessment tool.

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Until now, there has been no standard tool available to assess a radiology resident’s knowledge base at the end of their rotations.” Petra J. Lewis, MBBS, FACR, professor of radiology and OB-GYN and vice chair of education at the Geisel School of Medicine at Dartmouth, is setting the scene for RadExam, a joint project between the Association of Program Directors in Radiology (APDR) and the ACR.

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A Team Sport

The 2018 ACR-RBMA Practice Leaders Forum focused on radiologists as collaborators in the new healthcare paradigm.

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Team building in radiology was the central theme of the 2018 ACR-RBMA Practice Leaders Forum, held in Phoenix, in January. Lawrence R. Muroff, MD, FACR, CEO and president of Imaging Consultants, Inc., in Tampa, Fla., kicked off the discussion on teamwork by noting that the practice of radiology is changing, and radiologists must change with the practice.

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Analyze the Situation

UMMC’s quality and safety team uses SWOT analysis to identify improvement opportunities.

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When the University of Mississippi Medical Center’s (UMMC) radiology department formed a dedicated quality and safety team in 2014, the group was tasked with uncovering and addressing the department’s most pressing quality and safety issues. The team initiated its improvement efforts with a strengths, weaknesses, opportunities, and threats (SWOT) analysis — a process improvement tool for assessing an organization’s challenges and successes.

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Collaboration Delivers an Unusual Diagnosis

In a recent Case in PointCase of the Month, radiology and pathology converge to diagnose a rare tumor.

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Case in Point™ actively encourages its contributors to provide so-called zebra cases: diagnoses both rare and interesting. A recent Case of the Month meets these criteria while highlighting an essential component of radiology — cross-departmental collaboration.

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